Still some unknowns with delta and kids
The language from political leaders and health experts is stark. With the highly contagious delta variant spreading, this is a perilous time for people who are not vaccinated.
As San Francisco Mayor London Breed tweeted last week, “If you’re not vaccinated, it is likely not a matter of if you will get it, but when, and how bad it will be when you do.”
So where does that leave children under 12, who still are ineligible for the coronavirus vaccine and are soon heading back to their classrooms?
Cases of COVID19 among children have risen in San Francisco and across California in recent weeks, as they have among unvaccinated adults. But health experts say, compared to adults, children remain at relatively low risk for illness serious enough to require hospitalization, or death, even with the easiertocatch delta version of the virus.
Most children experience mild symptoms or none at all from the infection, and that hasn’t changed with the delta variant, said Dr. Susan Philip, San Francisco’s health officer. And the tried and true protective measures — masks in public places and handwashing — remain largely effective in preventing infections, she said.
For worried parents, “That is good and hopeful,” she said.
Even so, with much still unknown about the coronavirus itself, health experts are closely monitoring how children fare as vaccination rates fall short of the level needed for herd immunity protection. Research, for example, is exploring the prevalence and nature of socalled “long COVID” in youth — symptoms that can last for months but have been little studied in kids.
And even a small number of children who get seriously ill or die from COVID19 is not acceptable, Centers for Disease Control and Prevention Director Dr. Rochelle Walensky said during a recent U.S. Senate hearing.
There are clear risk factors, like obesity, that increase chances of serious illness in both children and adults, noted Dr. Yvonne Maldonado, a Stanford pediatric infectious disease expert. But it’s not always possible to predict which children will experience severe illness from COVID19.
Maldonado, who is leading a trial of the Pfizer coronavirus vaccine with children ages 2 to 5, recommends that parents return to mindsets of last year when face masks were commonplace.
“The bottom line is that I’m not highly concerned about children at this point — provided parents are using the same precautions,” Maldonado said.
In California, nearly 500,000 children have tested positive, about 13% of the state’s cases since the pandemic began. Twentyeight California children have died, among about 400 child COVID19 deaths nationwide, according to the CDC, which also states that babies under 1 and children with asthma, diabetes and other serious health conditions are at increased risk for severe COVID19 illness.
“The kids we’ve seen are often kids who have comorbidities, many with asthma and morbid obesity,” said Dr. Ann Petru, a pediatric infectious disease expert with UCSF Benioff Children's Hospital in Oakland.
Families of children with particular health concerns should consult their pediatricians, Petru said. Otherwise, the usual pandemic advice still stands.
“Yes on masks in public spaces where you’re in close proximity to others,” Petru said. “Outdoors in the park, running on the beach, you don’t have to wear a mask.” California on Wednesday updated its recommendations and called on everyone — even the vaccinated — to wear face masks in indoor public settings.
“We’ve learned a lot in the last year and a half, and we need to continue building on that,” agreed Oakland mom Sarah Jackel, chief operating officer of a political technology firm. “What we learned is kids aren’t very likely to get infected or get bad outcomes.”
Jackel voiced confidence in steps that she and her husband are taking to protect their children, ages 4 and 7, from the delta variant: wearing masks in indoor settings like grocery stores, postponing air travel, keeping a mask on their son at preschool but removing it at the playground or during other outdoor play.
In the first three weeks of July, San Francisco saw 138 new coronavirus cases among children 10 and younger, compared to 48 cases reported all of June. That rate was slightly higher than the increase among adolescents 12 and up, who are eligible for vaccination, but lower than adult infection rates.
The rise in cases follows California’s reopening on June 15, when most pandemic restrictions including mask mandates were lifted.
California’s statewide cases among children 17 and younger grew by 83% during the first two weeks of July compared to the two weeks that ended June 9 — which was just before the easing of restrictions and the increase in people going out and interacting more — according to Dr. George Lemp, a retired University of California epidemiologist who regularly analyzes state coronavirus data. Among all age groups, cases jumped 96%.
Lemp said rising infections among children, who like adults potentially could transmit virus even when they don’t show symptoms, create added risks of transmission to vulnerable adults — especially older people who have been most impacted by the virus.
One unknown is the extent to which children may develop “long COVID” — with longterm symptoms ranging from fatigue to inflammation. Petru said those cases are difficult to track because they typically don’t require hospitalization.
“It’s a topic of much discussion, but it hasn’t been resolved,” Petru said. “You’d think this far out (in the pandemic) we would have more data.”
The National Institute of Allergy and Infectious Diseases and Children’s National Hospital in Washington, D.C., are launching a $40 million multiyear study of long COVID in kids as well as multisystem inflammatory syndrome, a rare, serious immune response to COVID19.
Jackel’s biggest worry is that an overblown concern over the delta variant will threaten to shut down schools again.
“Academic loss has a much more deleterious impact on children than putting them in schools where they have a small risk” of contracting the virus, Jackel said.
Philip, San Francisco’s health officer, agrees, and her July 16 directive encouraged all schools to reopen for inperson instruction. Philip said there were few cases tied to private school and preschool campuses that remained open during the pandemic.
The best protective measure for children? Ensuring that all adults in a household get vaccinated, Philip said.
“For the kids who can’t get vaccinated,” she said, “the biggest risk factor is an unvaccinated adult in their life.”